糖尿病足溃疡患者多重耐药菌感染的流行病学调查研究
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杨美荣,本科,副主任医师,主要研究方向:内分泌疾病的防治

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R181

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Epidemiological investigation of multidrug-resistant bacterial infections in patients with diabetic foot ulcers
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    摘要:

    目的 分析糖尿病足溃疡患者多重耐药菌感染分布特点及耐药情况,并探究影响糖尿病足溃疡患者感染多重耐药菌的相关危险因素。方法 选取本院2021年1月-2023年12月收治的糖尿病足溃疡患者,对所有患者临床资料进行回顾性整理分析,收集所有患者溃疡创面标本,分析多重耐药菌感染情况及菌种耐药性,比较不同感染患者相关资料差异,采用多元logistic回归模型分析影响糖尿病足溃疡患者感染多重耐药菌的危险因素。结果 352例糖尿病足溃疡患者中,20.45%出现多重耐药菌感染,共检出91株菌,主要菌种为金黄色葡萄球菌(41.76%)、铜绿假单胞菌(24.18%)和肠杆菌(21.98%)。相比未感染患者,MDRI患者糖尿病病程、溃疡病程更长,Wagner分级3~5级、缺血性溃疡、多次住院、合并骨髓炎比例更高,溃疡面积更大,抗生素使用时间长(P<0.05)。多因素分析表明:糖尿病病程长、Wagner分级高、溃疡病程长、溃疡面积大、多次住院、抗生素使用时间长及合并骨髓炎均为MDRI的危险因素(P<0.05)。结论 糖尿病足溃疡患者具有多重耐药菌感染风险,而糖尿病病程较长、Wagner分级3-5级、入院前溃疡病程较长、溃疡面积较大、因同一伤口住院次数>2次/年、入院前抗生素使用时间过长及合并骨髓炎均可加大糖尿病足溃疡患者发生多重耐药菌感染的风险,因此,控制降低多重耐药菌感染是改善糖尿病足溃疡患者预后的关键。

    Abstract:

    Objective To analyse the distribution characteristics and drug resistance of multidrug-resistant bacteria infections in patients with diabetic foot ulcers, and to investigate the relevant risk factors affecting the infection of multidrug-resistant bacteria in patients with diabetic foot ulcers. Methods We selected 352 patients with diabetic foot ulcers admitted to our hospital from January 2021 to December 2023, and retrospectively collated and analysed the clinical data of all patients, collected the ulcer wound specimens of all patients, analysed the infection of multidrug-resistant bacteria and bacterial resistance, compared the differences in the relevant data of patients with different infections, and analysed the risk factors affecting the patients with diabetic foot ulcers by using multivariate logistic regression model. Multiple logistic regression model was used to analyse the risk factors affecting patients with diabetic foot ulcers infected with multi-drug resistant bacteria. Results A total of 352 patients with diabetic foot ulcers, 20.45% developed multidrug-resistant bacterial infections, and a total of 91 strains of bacteria were detected, with the predominant strains being Staphylococcus aureus (41.76%), Pseudomonas aeruginosa (24.18%) and Enterobacteriaceae (21.98%).Compared with uninfected patients, patients with MDRI had a longer duration of diabetes, longer duration of ulcers, a higher proportion of Wagner grade 3-5, ischaemic ulcers, multiple hospitalisations, combined osteomyelitis, larger ulcers, and a longer duration of antibiotic use (P < 0.05).Multifactorial analysis showed that long duration of diabetes mellitus, high Wagner grading, long duration of ulcer, large ulcer size, multiple hospitalisations, prolonged antibiotic use, and comorbid osteomyelitis were all risk factors for MDRI (P < 0.05). Conclusion Patients with diabetic foot ulcers are at risk of multi-resistant bacterial infections, and longer duration of diabetes mellitus, Wagner grade 3-5, longer duration of ulcers prior to hospitalisation, larger ulcer size, hospitalisation for the same wound >2 times/year, prolonged use of antibiotics prior to hospitalisation, and comorbidity with osteomyelitis can increase the risk of multi-resistant bacterial infections in patients with diabetic foot ulcers, therefore, controlling and reducing multi-resistant bacterial infections is the key to improving the prognosis of patients with diabetic foot ulcers.

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  • 收稿日期:2024-12-05
  • 最后修改日期:2024-12-05
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  • 在线发布日期: 2025-01-15
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